MEDICARE: BUDDYGUARD CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		CA

General Provider Information

NPI Number	:	1588043517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUDDYGUARD CORPORATION

Provider Business Mailing Address
First Line	:	8800 NEWCASTLE AVE
Second Line	:
City	:	SHERWOOD FOREST
State	:	CA
Zip	:	91325-3135
Country	:	US
Telephone Number	:	818-987-4700
Fax Number	:	818-725-1559

Provider Business Practice Location Address
First Line	:	8800 NEWCASTLE AVE
Second Line	:
City	:	SHERWOOD FOREST
State	:	CA
Zip	:	91325-3135
Country	:	US
Telephone Number	:	818-987-4700
Fax Number	:	818-725-1559

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAIL GOLDENBERG
Credential	:
Telephone Number	:	818-987-4700

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	10/19/2016

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